A "double burden" of prematurity and serious maternal complications occurs in one of 270 births

A quarter of women who have severe maternal complications during childbirth also have premature births, which is a "double burden" for families, according to a California Preterm NYU Rory Meyers College of Nursing study. Birth Initiative of the University of California at San Francisco (UCSF), and Stanford University.

The study, published online in Journal of Maternal-Fetal and Neonatal Medicine and the first, which focuses specifically on "double burden" births, shows that these complications occur in one of 270 births and are twice as likely to affect black mothers.

The situation of combined complications of the mother and the newborn will probably be extremely stressful for the families concerned by the health of the mother and the newborn. However, health care providers may not fully recognize it, especially when maternal and neonatal health care is provided by different specialists. There is not enough attention paid to the combined effect on the family. "

Audrey Lyndon, PhD, RN, FAAN, Professor of Nursing and Associate Dean of Clinical Research at NYU's Faculty of Nursing Rory Meyers, lead author of the study

Premature infants, born less than 37 weeks of age, have a variety of health problems, including breathing, digestion, heart rate, and developmental problems. Mothers may also face serious or even life-threatening health problems during childbirth. These maternal complications, also known as severe maternal morbidity, include serious bleeding requiring blood transfusion, blood clots, heart failure, emergency hysterectomies, and other serious problems. Research shows that severe maternal morbidity is rare, but that it is also increasing nationally, with rates more than doubling from 2002 to 2014 and may have permanent consequences for women and their families. families.

Although previous studies have shown badociations between premature birth and severe maternal morbidity, the prevalence of the "double burden" experience of the two has not been studied to date. Lyndon and his colleagues examined data from all births in California from 2007 to 2012, for a total of 3.1 million births. California maintains reliable birth data for its diverse population and accounts for about one in eight births in the United States.

The researchers found that preterm birth rates were 876 per 10,000 births and serious maternal morbidity rates were 140 per 10,000 births. A quarter of women with serious maternal morbidity, one per 270 births, also gave birth prematurely. The majority of these "double burden" births occurred in premature labor (61%) rather than early births due to medical reasons (23%).

Several factors were badociated with a higher risk of "double burden" childbirth, including birth by cesarean section, multiple wearing, smoking during pregnancy, underweight, hypertension and stroke. diabetes. The researchers also found that black women were twice as likely as white women to have a "double burden" at birth when they accounted for other factors.

"Racial disparities in health outcomes should be considered markers of exposure to racism, where poor health reflects exposure to chronic stress resulting from discrimination and structural inequality, rather than race being a "risk factor" for disease or poor health outcomes, "Lyndon said. "Our study suggests that exposure to racism for black families could lead to combined maternal and child health problems and illustrates the trans-generational impact of such exposure."

Dual births have immediate, ongoing physical, psychological, social and financial consequences for women and their families. In addition, the experience can trigger post-traumatic stress disorder (PTSD) in women and their partners, resulting in consequences such as altered attachment of parents to the child, deterioration of relationships between partners, prolonged suffering and feelings of failure. These consequences could add to what may already be racialized birth experiences for black families, with black women reporting disrespectful encounters when they use reproductive health services and black premature neonates less likely to be referred for development follow-up.

"Imagine the deep trauma experienced by a family when the mother and newborn simultaneously struggle for their lives," said Laura Jelliffe-Pawlowski, PhD, MS, badociate professor of epidemiology and biostatistics at the University of Toronto. UCSF School of Medicine, Director of Precision Health Discovery with the UCSF California Preterm Birth Initiative and the lead author of the study. "That's the reality for 1,900 families in California, and that can have a huge impact on all generations, especially for black families, who are more likely to have a double birth."

Since mothers and newborns are supported by different teams of specialists, researchers point to the need for new models of care that explicitly coordinate maternal and child health care teams and proactively support the transition. from family to home and long-term health.